Risk Factors For Postpartum Hemorrhage Research Articles

Establishment of Risk Nomogram Model of Postpartum Hemorrhage After Second Cesarean Section.

To establish and evaluate a nomogram model for predicting the risk of postpartum hemorrhage in second cesarean section. A total of 440 parturients who underwent the second cesarean section surgery and were registered in our hospital from August 2019 to July 2021 were selected as the study subjects. They were randomly divided into 220 modeling group and 220 validation group based on simple randomization. The two groups were divided into postpartum hemorrhage group and postpartum non bleeding group according to whether postpartum hemorrhage occurred. In the modeling group, the incidence of postpartum hemorrhage in the second cesarean section was 15.00%; the Logistic regression model showed that placenta previa, operation time, prenatal anemia, placenta accreta, uterine inertia were the independent risk factors of postpartum hemorrhage in the second cesarean section (P < 0.05). ROC results showed that AUC of predicting the risk of postpartum hemorrhage in the second cesarean section was 0.824. The slope of calibration curve is close to 1, Hosmer-Lemeshow goodness of fit test showed x2= 7.585, P = 0.250. The external verification results show that the AUC is 0.840, and the predicted probability of the calibration curve is close to the actual probability. Based on the five risk factors of postpartum hemorrhage in the second cesarean section, including placenta previa, operation time, prenatal anemia, placenta accreta and uterine inertia, the nomogram model for predicting the risk of postpartum hemorrhage in the second cesarean section has good accuracy and differentiation.

Predicting risk of postpartum hemorrhage associated with vaginal delivery of twins: A retrospective study.

Many studies have only focused on the risk factors for postpartum hemorrhage (PPH) in singleton vaginal deliveries and twin cesarean deliveries. We analyzed the factors of influencing PPH occurrence in twin vaginal deliveries and developed a nomogram for clinical application. This retrospective study included 274 pregnant women with twin pregnancies who were hospitalized for delivery from January 2014 to December 2018. The patients opted for vaginal delivery and experienced spontaneous labor. Univariate analysis of PPH risk factors was performed. Multivariate analysis was performed using the least absolute shrinkage and selection operator (LASSO) to obtain relevant factors and build a prediction model, which was presented as a nomogram. The model was internally validated by bootstrap self-sampling method. Model accuracy was evaluated with the concordance index (C-index). There were 36 (13.14%) and 238 (86.9%) patients in the PPH and no PPH groups, respectively. Univariate analysis identified twin chorionicity, hypertensive disorders complicating pregnancy (HDCP), anemia in pregnancy, delivery mode of the second twin, oxytocin use during labor, postpartum curettage, cervical laceration, intrapartum fever, fibrinogen degradation products (FDP), and platelet count (PLT) as significant PPH factors. On multivariate analysis, HDCP, anemia in pregnancy, intrapartum fever, oxytocin use during labor, fetal distress, PLT, direct bilirubin, and FDP were noted as significant PPH factors and were included in the prediction model. A C-index of 0.816 was noted after internal validation, and the calibration curve showed good consistency. We developed a model to predict PPH risk in the vaginal delivery of twin pregnancies and visualized it with a nomogram that can be applied clinically to assess PPH risk and aid PPH prevention.

Risk Factor for Postpartum Hemorrhage in The Post-Disaster (2019-2021)

The earthquake disaster in Palu in 2018, followed by the pandemic in 2020, caused mobility to be hampered and affected people's habits and lifestyles, who mostly stayed at home and had no activities. This also affected pregnant women who just stayed at home because they were afraid. The impact of the pandemic will result in less physical activity and less interaction with health workers, causing pregnant women to experience macrosomia. This research aims to determine the risk factors for postpartum hemorrhage at Anutapura Public Hospital in Palu. This research was an analytic observational with a case-control approach. Case subjects were mothers who experienced postpartum hemorrhage, and controls were mothers who did not experience postpartum hemorrhage. Case samples were 67 people, and controls were 67 people with age matching. A simple random sampling technique was carried out for sampling. The data source used secondary data, medical records for 2019-2021. Data analysis used the odds ratio test. The results showed that macrosomia (OR=4.543 and CI=1.421-14.528), prolonged labor (OR=3.674 and CI=1.720-7.850), and parity (OR=2.452 and CI=1.199-5.014) a risk factor for postpartum hemorrhage. Postpartum hemorrhage is significantly associated with low-risk macrosomia, low-risk parity, and safe parity

Risk factors for postpartum haemorrhage in women with histologically verified placenta accreta spectrum disorders: a retrospective single-centre cross-sectional study

BackgroundPlacenta accreta spectrum (PAS) disorders have been reported with an increasing frequency of up to 3%. The increase in the incidence can be explained by the rising rate of Caesarean section (CS), assisted reproductive technology (ART) and previous uterine surgeries. PAS disorders are usually associated with postpartum haemorrhage (PPH). In our study, we investigated the risk factors for increased blood loss in women with histologically verified PAS disorders independent of delivery mode.MethodsIn a retrospective single-centre cross-sectional study, 2,223 pregnant women with histologically verified PAS disorders were included. Risk factors for PPH in women with PAS disorders were examined and compared between women with PPH (study group; n = 879) and women with normal blood loss (control group; n = 1150), independent of delivery mode. PAS disorders were diagnosed histologically from the following specimens: placenta, placental-bed specimens, uterine curettage, uterine resection and/or total/partial hysterectomy. Medical data were extracted from clinical records of pregnant women with PAS disorders delivering at the University Hospital Basel between 1986 and 2019. The placenta data of women with PAS disorders were obtained and identified through a search from the database of the Department of Pathology, University Hospital Basel.ResultsBetween 1986 and 2019, there were 64,472 deliveries at the University Hospital Basel. PAS disorders were histologically verified in 2,223 women (2,223/64,472), and the prevalence of PAS disorders was 3.45%. A total of 879 women with PAS disorders showed PPH, independent of delivery mode (43.3%). Due to missing data for 194 women, the final analysis was conducted with the remaining 2,029 women. Placenta praevia (O.R. = 6.087; 95% CI, 3.813 to 9.778), previous endometritis (O.R. = 3.011; 95% CI, 1.060 to 9.018), previous manual placenta removal (O.R. = 2.530; 95% CI, 1.700 to 3.796), ART (O.R. = 2.169; 95% CI, 1.593 to 2.960) and vaginal operative birth (O.R. = 1.715; 95% CI, 1.225–2.428) can be considered important risk factors, and previous CS (O.R. = 1.408; 95% CI, 1.016 to 1.950) can be considered a moderate potential risk factor of PPH in women with PAS disorders.ConclusionsPlacenta praevia, previous endometritis, previous placenta removal, ART and vaginal operative birth can be considered important risk factors of PPH in women with PAS disorders.Study registrationThe study was registered under http://www.ClinicalTrials.gov (NCT05542043) on 15 September 2022.

Postpartum haemorrhage occurring in UK midwifery units: A national population-based case-control study to investigate incidence, risk factors and outcomes.

To estimate the incidence of, and investigate risk factors for, postpartum haemorrhage (PPH) requiring transfer to obstetric care following birth in midwifery units (MU) in the UK; to describe outcomes for women who experience PPH requiring transfer to obstetric care. We conducted a national population-based case-control study in all MUs in the UK using the UK Midwifery Study System (UKMidSS). Between September 2019 and February 2020, 1501 women with PPH requiring transfer to obstetric care following birth in an MU, and 1475 control women were identified. We used multivariable logistic regression, generating adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to investigate risk factors for PPH requiring transfer to obstetric care. The incidence of PPH requiring transfer to obstetric care following birth in an MU was 3.7% (95% CI 3.6%-3.9%). Factors independently associated with PPH requiring transfer to obstetric care were smoking during pregnancy (aOR = 0.73; 95% CI 0.56-0.94), nulliparity (aOR = 1.96; 95% CI 1.66-2.30), previous PPH (aOR = 2.67; 95% CI 1.67-4.25), complications in a previous pregnancy other than PPH (aOR = 2.40; 95% CI 1.25-4.60), gestational age ≥41 weeks (aOR = 1.36; 95% CI 1.10-1.69), instrumental birth (aOR = 2.69; 95% CI 1.53-4.72), third stage of labour ≥60 minutes (aOR = 5.56; 95% CI 3.93-7.88), perineal trauma (aOR = 4.67; 95% CI 3.16-6.90), and birthweight 3500-3999g (aOR = 1.71; 95% CI 1.42-2.07) or ≥4000g (aOR = 2.31; 95% CI 1.78-3.00). One in ten (10.6%) cases received a blood transfusion and one in five (21.0%) were admitted to higher level care. The risk factors identified in this study align with those identified in previous research and with current guidelines for women planning birth in an MU in the UK. Maternal outcomes after PPH were broadly reassuring and indicative of appropriate management. NHS organisations should ensure that robust guidelines are in place to support management of PPH in MUs.

Plasenta previa tanısı olan gebelerde hafif trombositopeni ile postpartum kanama ilişkisi

ABSTRACT&#x0D; Aim&#x0D; Postpartum hemorrhage (PPH) is a major cause of maternal mortality and morbidity. Although thrombocytopenia is one of the known risk factors for postpartum hemorrhage, little is known about the effect of mild thrombocytopenia on PPH. The current study aimed to investigate the relationship between postpartum hemorrhage and mild thrombocytopenia in pregnant women with placenta previa. &#x0D; Method&#x0D; We conducted a retrospective cohort study of pregnant women who underwent placenta previa surgery between October 1, 2019 and May 1, 2022. Women with mild thrombocytopenia (platelet count 100,000-149,999/ µl) comprised the study group. The women in the control group had normal platelet counts (platelet count 150.000- 450.000 / µl). The outcome was the incidence of postpartum hemorrhage which is a combination of one or more of the following: 1) the requirement for a transfusion of pRBC during the intraoperative or postpartum period; 2) a decrease in Hb levels of at least 3 gr/dL postpartum compared to prepartum.&#x0D; Results&#x0D; There were 170 women in the study; 30 were in the group with mild thrombocytopenia and 140 were in the control group. Mild thrombocytopenia was found to be associated with postpartum hemorrhage (adjusted odds ratio: 3.90 95% CI: 1.56-9.72). Also in the mild thrombocytopenia group, the number of patients receiving blood transfusion and Hb decline &gt;3 g/dL were significantly higher compared to the control group (p

Postpartum hemorrhage in Sub-Saharan Africa—a prospective study in metropolitan Mozambique

BackgroundEstimates indicate approximately ≈500 to 1000 maternal deaths per 100,000 live births in Sub-Saharan Africa (SSA) (vs ≈5-20 in developed countries). Postpartum hemorrhage (PPH) seems a major contributor to maternal mortality (MM), but there are no comprehensive data for the region. ObjectivesAnalyze MM, PPH, and associated risk factors. MethodsWe collected prospective data on MM, PPH, and associated risk factors in metropolitan Mozambique. We recorded consecutive deliveries at the Maputo Central Hospital between February 2019 and January 2021. Data included age, HIV status, parity, delivery mode, notes, vital signs, laboratory values, and fetal parameters. PPH was determined by charted diagnosis, blood loss of >500 mL, transfusion, and/or notes indicating significant bleeding. ResultsOf 8799 deliveries, ≈40% occurred in women residing outside Maputo City (“nonlocal”), with similar demographic characteristics between local and nonlocal women. However, compared with local women, nonlocal women had worse outcomes, including higher rates of MM (1.52% vs 0.78%; P =.0012) and PPH (16.51% vs 12.39%; P <.0001), whereby PPH was strongly associated with MM (adjusted odds ratio = 5.56; P <.0001). Almost all women with uterine atony (≈1%) experienced PPH. For women receiving laboratory tests on admission (drawn only if in distress; local, n = 561; nonlocal, n = 514), both cohorts revealed similar distributions of hemoglobin levels and platelet counts. Prepartum anemia (≈57%) and thrombocytopenia (≈21%) were prominent risk factors for PPH; risk increased with increasing severity and was additive in the presence of both. ConclusionsPPH is a serious problem in Maputo province, a metropolitan area of SSA, portending high MM. Identification of correctable risk factors, including anemia, should catalyze the development of region-specific prevention protocols.

Fibrinolytic potential as a risk factor for postpartum hemorrhage.

Postpartum hemorrhage (PPH) is still the leading cause of maternal morbidity and mortality worldwide. While impaired fibrin polymerization plays a crucial role in the development and progress of PPH, recent approaches using viscoelastic measurements have failed to sensitively detect early changes in fibrinolysis in PPH. This study aimed to evaluate whether women experiencing PPH show alterations in POC-VET fibrinolytic potential during childbirth and whether fibrinolytic potential offers benefits in the prediction and treatment of PPH. Blood samples were collected at three different timepoints: T0 = hospital admission (19 h ± 18 h prepartum), T1 = 30-60 min after placental separation, and T2 = first day postpartum (19 h ± 6 h postpartum). In addition to standard laboratory tests, whole-blood impedance aggregometry (Multiplate) and viscoelastic testing (VET) were performed using the ClotPro system, which included the TPA-test lysis time, to assess the POC-VET fibrinolytic potential, and selected coagulation factors were measured. The results were correlated with blood loss and clinical outcome markers. Severe PPH was defined as a hemoglobin drop > 4g/dl and/or the occurrence of shock or the need for red blood cell transfusion. Blood samples of 217 parturient women were analyzed between June 2020 and December 2020 at Heidelberg University Women's Hospital, and 206 measurements were eligible for the final analysis. Women experiencing severe PPH showed increased fibrinolytic potential already at the time of hospital admission. When compared to non-PPH, the difference persisted 30-60 min after placental separation. A higher fibrinolytic potential was accompanied by a greater drop in fibrinogen and higher d-dimer values after placental separation. While 70% of women experiencing severe PPH showed fibrinolytic potential, 54% of those without PPH showed increased fibrinolytic potential as well. We were able to show that antepartal and peripartal fibrinolytic potential was elevated in women experiencing severe PPH. However, several women showed high fibrinolytic potential but lacked clinical signs of PPH. The findings indicate that high fibrinolytic potential is a risk factor for the development of coagulopathy, but further conditions are required to cause PPH.

Establishment of a predictive model for postpartum hemorrhage in twins: a retrospective study

ObjectiveTo explore the risk factors and develop a predictive model for postpartum hemorrhage in twin pregnancies.MethodsAll patients who gave birth at Ningbo Women and Children’s Hospital from January 2018 to August 2022 were recruited. Patients were randomly allocated to a training cohort (n=1395) validation cohort (n=650) at a 7:3 ratio. In the training cohort, LASSO regression for screening variables and multifactorial logistic regression analysis were performed to identify independent risk factors for postpartum hemorrhage in twin pregnancies. A nomogram was established based on the results of multiple logistic regression analysis. Nomogram performance was quantified using the receiver operating characteristic curve, Hosmer- Lemeshow test and decision curve analysis.ResultsA total of 2045 patients were included in this study. Multifactorial Logistic regression analysis showed maternal age, assisted reproduction, platelet count, fibrinogen level, albumin level, hypertensive disorders of pregnancy, placenta praevia, number of previous cesarean deliveries, number of previous intrauterine manipulation, and neonatal weight were independent risk factors for postpartum hemorrhage in twin births. The area under curve (AUC) for the training cohort was 0.810 [95% CI (0.781, 0.839)], with a sensitivity of 76.5%, specificity of 71.0%, and positive and negative predictive values of 0.358 and 0.935, respectively, while the AUC for the validation cohort was 0.821 [95% CI (0.781, 0.860)], with a sensitivity of 80.9%, specificity of 69.49%, and positive predictive value and negative predictive value of 0.426 and 0.929, respectively.ConclusionThe predictive model can effectively and quantitatively assess the risk of postpartum hemorrhage in twin pregnancies and help clinicians to take personalized preventive measures.

Anemia Prenatal is A Risk Factor for Postpartum Hemorrhage

Postpartum Hemorrhagic is still the main cause of maternal death. While anemia is a major contributor to maternal morbidity, therefore, to prevent Postpartum Hemorrhagic (PPH), it is important to be aware of the occurrence of anemia during pregnancy. The purpose of this study was to determine the relationship between anemia in pregnancy and postpartum hemorrhagic events at the Sukodono Health Center, Sidoarjo. This research is an observational study with a cross sectional approach. The population in this study was 125 respondents, a sample of 42 respondents was obtained using purposive sampling technique. Data collection used secondary data (medical records January - December 2022). Data were analyzed using the Fisher's Exact Test statistic with a significance level of α (0.05). The results showed that the ρ-value = 0.008, meaning that ρ (0.008) &lt; α (0.05) or H1 is accepted: there is a relationship between anemia in pregnancy and the incidence of postpartum hemorrhagic (PPH) at the Sukodono Health Center, Sidoarjo Regency. Pregnancy with anemia in the third trimester has a high risk of experiencing Postpartum Hemorrhagic, so it is necessary to increase awareness of anemia by optimizing integrated antenatal care services.

Enhancing postpartum hemorrhage prediction in pernicious placenta previa: a comparative study of magnetic resonance imaging and ultrasound nomogram.

Objective: To explore the risk factors of postpartum hemorrhage (PPH) in patients with pernicious placenta previa (PPP) and to develop and validate a clinical and imaging-based predictive model. Methods: A retrospective analysis was conducted on patients diagnosed surgically and pathologically with PPP between January 2018 and June 2022. All patients underwent PPP magnetic resonance imaging (MRI) and ultrasound scoring in the second trimester and before delivery, and were categorized into two groups according to PPH occurrence. The total imaging score and sub-item prediction models of the MRI risk score/ultrasound score were used to construct Models A and B/Models C and D. Models E and F were the total scores of the MRI combined with the ultrasound risk and sub-item prediction model scores. Model G was based on the subscores of MRI and ultrasound with the introduction of clinical data. Univariate logistic regression analysis and the logical least absolute shrinkage and selection operator (LASSO) model were used to construct models. The receiver operating characteristic curve andision curve analysis (DCA) were drawn, and the model with the strongest predictive ability and the best clinical effect was selected to construct a nomogram. Internal sampling was used to verify the prediction model's consistency. Results: 158 patients were included and the predictive power and clinical benefit of Models B and D were better than those of Models A and C. The results of the area under the curve of Models B, D, E, F, and G showed that Model G was the best, which could reach 0.93. Compared with Model F, age, vaginal hemorrhage during pregnancy, and amniotic fluid volume were independent risk factors for PPH in patients with PPP (p < 0.05). We plotted the DCA of Models B, D, E, F, and G, which showed that Model G had better clinical benefits and that the slope of the calibration curve of Model G was approximately 45°. Conclusion: LASSO regression nomogram based on clinical risk factors and multiple conventional ultrasound plus MRI signs has a certain guiding significance for the personalized prediction of PPH in patients with PPP before delivery.

Risk factors for severe postpartum hemorrhage requiring blood transfusion after cesarean delivery for twin pregnancy: a nationwide cohort study.

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality. Twin pregnancy and cesarean delivery are well-known risk factors for PPH. However, few studies have investigated PPH risk factors in mothers who have undergone cesarean delivery for twin pregnancies. Therefore, this study investigated the risk factors associated with severe PPH after cesarean delivery for twin pregnancies. We searched and reviewed the Korean Health Insurance Review and Assessment Service's claims data from July 2008 to June 2021 using the code corresponding to cesarean delivery for twin pregnancy. Severe PPH was defined as hemorrhage requiring red blood cell (RBC) transfusion during the peripartum period. The risk factors associated with severe PPH were identified among the procedure and diagnosis code variables and analyzed using univariate and multivariate logistic regressions. We analyzed 31,074 cesarean deliveries for twin pregnancies, and 4,892 patients who underwent cesarean deliveries for twin pregnancies and received RBC transfusions for severe PPH were included. According to the multivariate analysis, placental disorders (odds ratio, 4.50; 95% confidence interval, 4.09-4.95; P < 0.001), general anesthesia (2.33, 2.18-2.49; P < 0.001), preeclampsia (2.20, 1.99-2.43; P < 0.001), hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome (2.12, 1.22-3.68; P = 0.008), induction failure (1.37, 1.07-1.76; P = 0.014), and hypertension (1.31, 1.18-1.44; P < 0.001) predicted severe PPH. Placental disorders, hypertensive disorders such as preeclampsia and HELLP syndrome, and induction failure increased the risk of severe PPH after cesarean delivery for twin pregnancy.

Risk factors for postpartum haemorrhage in twin pregnancies and haemorrhage severity.

This study evaluated risk factors for postpartum haemorrhage (PPH) in twin pregnancies, particularly factors associated with major PPH (blood loss of >1000 mL), to facilitate identification of high-risk twin pregnancies. This retrospective cohort study included all women with twin pregnancies who delivered at a tertiary obstetric unit in Hong Kong from 2009 to 2018 and experienced PPH (blood loss of ≥500 mL). Postpartum haemorrhage was classified using three thresholds for blood loss volume: ≥500 mL (all PPH), >1000 mL (major PPH), and >1500 mL (severe PPH). Risk factors for each threshold of PPH were analysed. In total, there were 680 twin pregnancies. The overall incidence of all PPH (≥500 mL) in this cohort was 27.8%, including minor PPH (500-1000 mL, 20.1%), major but not severe PPH (1001-1500 mL, 4.4%), and severe PPH (>1500 mL, 3.2%). Logistic regression analysis showed that general anaesthesia and the use of oxytocin were significant risk factors for all PPH (≥500 mL); general anaesthesia, in vitro fertilisation, antepartum haemorrhage, placental abruption, and placenta praevia were significant risk factors for major PPH (>1000 mL); in vitro fertilisation, placenta praevia, and obesity were significant risk factors for severe PPH (>1500 mL). Women with twin pregnancies who have obesity, conception by in vitro fertilisation, or placenta praevia exhibit a high risk of severe PPH. They should deliver in obstetric units with readily available blood product transfusions and the appropriate expertise for prompt management of severe PPH.

Prevention of Post-Partum Hemorrhage: Comparison of Oxytocin and Misoprostol. A Two center study in the Bamenda and Nkwen Health Districts

Background: Postpartum hemorrhage is one of the most common obstetrical complications affecting up to 18% of deliveries. Globally, it is responsible for 35 – 55% of peripartum maternal deaths. In Cameroon, the maternal mortality rate is at 406 maternal death per 100,000 live births, with PPH being the leading cause accounting for about 25%. This study aimed to compare the efficacy and safety of misoprostol versus oxytocin in the prevention of postpartum hemorrhage in the Bamenda Health District and Nkwen Health District. Methods: This was a hospital-based randomized clinical trial study in the Bamenda Regional Hospital and Nkwen District Hospital. The study was conducted from March 1st to May 31st 2021 including pregnant women who delivered at the maternity at these two hospitals. All their pregnancy was singleton gestation at term and haven given their informed consent. Women with known history of cardiac, renal, hepatic diseases or any coagulopathy, Cesarean delivery were excluded. We randomized 308 participants in a 1:1 ratio to receive 800 μg of oral misoprostol or 10IU of oxytocin intramuscularly during the active management of third stage of labor (AMSTL). The Hemoglobin (Hb) concentration and hematocrit (HCT) of the participants were measured before and 24hrs after delivery. Our primary outcome of interest was (Post-Partum Hemorrhage) PPH, defined as Hb change ≥ 1g/dl within 24hrs of delivery. Secondary outcomes included; mean Hb change, Hb change ≥2g/dl (severe PPH). Dichotomous outcomes between study groups were compared by estimating crude relative risks (RRs) with 95% confidence intervals. Logistic regression (the chi-square test) was done to determine the factors associated with the occurrence of postpartum hemorrhage, with a level of significance at 5%. Results: After 24hrs, Postpartum hemorrhage (PPH) occurred in 41 (26.6%) and 47 (30.5%) participants in the misoprostol and oxytocin groups respectively (RR= 0.87, 95% C.I= 0.61 - 1.24, p=0.449). Severe postpartum hemorrhage occurred in 3 (1.9%) and 5 (3.2%) participants in the misoprostol and oxytocin groups respectively (RR= 0.6, 95% C.I=0.15 - 2.47, p=0.723). Past history of PPH (aOR=10.1 (3.5 – 28.6), p&lt;0.0001), augmentation of labor (aOR=3.4 (1.6 – 7.1), p=0.0011), fetal birth weight ≥3.5Kg (aOR=2.5 (1.3 – 4.8), p=0.0074) and retained products (aOR= 8.4 (4.2 – 16.7), p&lt;0.0001) were risk factors of PPH. Participants in the misoprostol group more commonly experienced shivering (RR 3.2, 95% CI 2.0 - 5.1, p&lt;0.0001) and nausea/vomiting (RR 35.5, 95% CI 8.9 – 142.2, p&lt;0.0001). Conclusion: Oral misoprostol at the dose of 800μg is as effective as 10 IU IM Oxytocin in the prevention of PPH and is a potent alternative to oxytocin. Most common risk factors of PPH are past history of PPH, augmentation of labor, fetal weight ≥ 3.5kg and retained products. Side effects were mostly associated with 800μg of oral Misoprostol.

Family history of postpartum hemorrhage is a risk factor for postpartum hemorrhage after vaginal delivery: results from the French prospective multicenter Haemorrhages and Thromboembolic Venous Disease of the Postpartum cohort study

Postpartum hemorrhage (PPH) is a major component of perinatal morbidity and mortality affecting young women worldwide, and is still often unpredictable. Reducing the incidence of PPH is a major health issue, and identifying women at risk for PPH is a key element in preventing this complication. To estimate PPH prevalence after vaginal delivery and to identify PPH risk factors. Unselected pregnant women ≥ 16 years attending one of six maternity wards in Brittany (France) for vaginal birth after 15 weeks of gestation were recruited in this prospective multicenter cohort study between June 1, 2015 and January 31, 2019. PPH was defined as a blood loss ≥ 500 mL in the 24 hours following delivery. Independent risk factors for PPH were determined by logistic regression. Missing data were compensated by multiple imputation (MICE method). Among 16,382 included women, PPH prevalence was 5.37%. A first-degree family history of PPH (aOR = 1.63, 95%CI 1.24-2.14) and a personal transfusion history (aOR = 1.90, 95%CI 1.23-2.92) were significantly associated with PPH. The use of oxytocin during labor was also a risk factor for PPH (aOR = 1.24, 95%CI 1.06-1.44). Inversely, smoking during pregnancy and intrauterine growth restriction were associated with a reduced risk of PPH (aOR = 0.76, 95%CI 0.63-0.91, and 0.34, 95%CI 0.13-0.87, respectively). In addition to classical risk factors, this study identified PPH family history and personal transfusion history as new characteristics associated with PPH after vaginal delivery. The association of PPH with a family history of PPH suggests a hereditary hemorrhagic phenotype and calls for genetic studies. Identifying women at risk for PPH is a key element in being prepared for this complication.

Incidence and Risk Factors for Postpartum Hemorrhage: A Case-Control Study in a Tertiary Hospital in Greece.

Background and Objectives: Postpartum hemorrhage (PPH) is an obstetrical emergency and although the mortality rate from PPH has decreased, it is still considered a challenge in obstetrics. This study aimed to estimate the rate of primary PPH, as well as to investigate the potential risk factors and management options. Material and methods: This was a retrospective case-control study of all cases with PPH (blood loss > 500 mL, irrespective of the mode of delivery) managed in the Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece, from 2015 to 2021. The ratio of cases to controls was estimated to be 1:1. The chi-squared test was used to examine if there was any relationship between several variables and PPH, while subgroup multivariate logistic regression analyses of certain causes of PPH were also conducted. Results: During the study period, from a total of 8545 births, 219 (2.5%) pregnancies were complicated with PPH. A maternal age > 35 years (OR: 2.172; 95% CI: 1.206-3.912; p = 0.010), preterm delivery (<37 weeks) (OR: 5.090; 95% CI: 2.869-9.030; p < 0.001) and parity (OR: 1.701; 95% CI: 1.164-2.487; p = 0.006) were identified as risk factors for PPH. Uterine atony was the main cause of PPH in 54.8% of the women, followed by placental retention in 30.5% of the sample. Regarding management, 57.9% (n = 127) of the women received uterotonic medication, while in 7.3% (n = 16), a cesarean hysterectomy was performed to control PPH. Preterm delivery (OR: 2.162; 95% CI: 1.138-4.106; p = 0.019) and delivery via a cesarean section (OR: 4.279; 95% CI: 1.921-9.531; p < 0.001) were associated with a higher need for multiple treatment modalities. Prematurity (OR: 8.695; 95% CI: 2.324-32.527; p = 0.001) was identified as an independent predictor for an obstetric hysterectomy. From the retrospective analysis of the births complicated by PPH, no maternal death was identified. Conclusions: Most of the cases complicated with PPH were managed with uterotonic medication. An advanced maternal age, prematurity and multiparity had a significant impact on the occurrence of PPH. More research is needed on the risk factors of PPH, while the establishment of validated predictive models would be of value.

Improving blood product management in placenta accreta patients with severe bleeding: institutional experience

BackgroundPlacenta accrete spectrum (PAS) is a significant risk factor for postpartum hemorrhage and effective blood product management is critical in ensuring patient safety. In PAS patients undergoing cesarean section (CS) blood transfusion management guided by the combined clinical experience of the anesthesiologist and surgeon with point-of-care coagulation testing appears safe and effective. We describe and evaluate our experience and identify potential areas for improvement with blood product management in this patient population. MethodsA retrospective chart review of peri-operative demographic, anesthetic, and obstetric data was conducted for all patients with PAS undergoing CS between 2012 and 2018 at our center. To facilitate a practical evaluation of blood product management, we divided patients into two groups based on the severity of bleeding. ResultsA total of 221 parturients with PAS underwent CS, with 133 in group 1 requiring excessive amounts of transfusion and 88 in group 2 requiring management similar to other uncomplicated CS cases. There were no deaths or instances of disseminated intravascular coagulation, and intensive care unit admission occurred in five cases (2.2%). Patients in group 1 had higher mean nadir values of intra-operative hemoglobin and platelet count. We observed a high rate of missing data for peri-operative measurement of lactate and fibrinogen, PAS grade documentation, and temperature monitoring. ConclusionGiven no significant morbidity or mortality, clinical judgment in experienced centers appears safe for the management of PAS patients undergoing CS. The adoption of an institutional protocol and point-of-care coagulation testing could decrease over-transfusion and associated complications.

Incidence and risk factors for severe postpartum haemorrhage in women with anterior low-lying or praevia placenta and prior caesarean: prospective population-based study.

To assess the incidence and risk factors for severe postpartum haemorrhage (PPH) in women with an anterior low-lying or praevia placenta, prior caesarean and no prenatal suspicion of placenta accreta spectrum (PAS). Population-based study in 176 maternity units in France. All women with anterior low-lying (0-19 mm from the cervical internal os) or praevia placenta, diagnosed prospectively before birth, prior caesarean and no prenatal suspicion of PAS. Multivariable logistic regression to identify risk factors for severe PPH in the main population and after exclusion of women with PAS diagnosed only at birth. Severe PPH defined by a composite criterion either estimated blood loss of ≥1500 ml, transfusion of ≥4 or more units of packed red blood cells, embolisation or surgical treatment. Of the 520 114 women constituting the source population, 230 (0.44/1000 women; 95% confidence interval [CI] 0.38-0.50) met the inclusion criteria. Severe PPH rate was 24.8% (95% CI 19.2-30.4) overall, 27.5% (95% CI 21.8-33.3) in women with placenta praevia and 15.4% (95% CI 10.7-20.0) in women with low-lying placenta. PAS was diagnosed at birth in 22 women (9.9%; 95% CI 5.8-13.4), although previously unsuspected. After their exclusion, severe PPH incidence was 17.3% (95% CI 12.4-22.2). In multivariate analysis, the only factor associated with a higher severe PPH risk was placenta previa (aOR, 3.65; 95%CI, 1.20-15.8). Severe PPH is frequent among women with anterior low-lying or praevia placenta and prior caesarean, even after exclusion of women with PAS. The risk of severe PPH for those with praevia is nearly twice that with low-lying placenta.

Prevalence and Risk Factors of Postpartum Hemorrhage in Cesarean Section: A Retrospective Cohort Study

Prevalence and Risk Factors of Postpartum Hemorrhage in Cesarean Section: A Retrospective Cohort Study

Risk factors of postpartum hemorrhage due to uterine atony: a retrospective cohort study

Background: Postpartum hemorrhage (PPH) continues to be a significant global burden leading to high maternal mortality and morbidity rates. Uterine atony is the most prevalent cause of postpartum hemorrhage, accounting for 75% to 90% of cases.&#x0D; Aim: Research uterine atony related PPH at Hospital of Hue University of Medicine and Pharmacy’s Department of Obstetrics and Gynecology.&#x0D; Materials and methods: In this study, we conducted a retrospective case-control study to determine the risk factors for PPH among a cohort of women who gave birth between August 2020 and June 2021 at the Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy Hospital. PPH was defined as an estimated blood loss ≥500 mL. Logistic regression analysis was used to identify independent risk factors for PPH.&#x0D; Results: After the vaginal deliveries, we collected data from 147 patients, including 49 women with PPH caused by uterine atony and 98 without PPH. Maternal characteristics significantly associated with PPH included: pre-delivery anemia (adjusted OR [aOR] 4.0, 95% Confidence interval [CI]: 1.7 - 11.2), macrosomia (aOR = 4.3; 95%CI 1.1 - 16.8) and grand parity (aOR = 4.7; 95%CI: 1.7 - 13.9).&#x0D; Conclusions: All pregnant women should have their risks associated with postpartum hemorrhage evaluated and monitored during their pregnancies’ prenatal, labor, and postpartum stages.